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<meta name="description" content="还是一个模块发一篇吧。模块4：使用口镜(Use of the Dental Mouth Mirror)恰当使用口镜可以显著的增加医生保持一个自然工作体位的能力。本模块包括：①在患者口内保持口镜稳定；②牙周治疗中口镜的作用；③间接视觉对正确体位的重要性，以及④对前牙区域的反射。Section1：口镜使用基础(Fundamentals of Mirror Use)牙科口镜的类型（我们最常用的塑料一次性">
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        <p>还是一个模块发一篇吧。<br>模块4：使用口镜(Use of the Dental Mouth Mirror)<br>恰当使用口镜可以显著的增加医生保持一个自然工作体位的能力。本模块包括：①在患者口内保持口镜稳定；②牙周治疗中口镜的作用；③间接视觉对正确体位的重要性，以及④对前牙区域的反射。<br>Section1：口镜使用基础(Fundamentals of Mirror Use)<br>牙科口镜的类型<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/01.jpg"><br>（我们最常用的塑料一次性口镜应该就是平面型的，有重影）<br>在口腔中使用口镜的稳定性<br>在牙周治疗中支点为医生的手的稳定提供支持。<br>用非主利手握持口镜。无名指和示指用来在口腔中稳定口镜。可以用患者的颏部，面颊(口外支点）或牙齿表面（口内支点）来做支点稳定口镜。<br>口镜的功能<br>①间接影像；②阻挡（retraction，舌头等）；③间接照明；④透射。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/02.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/03.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/04.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/05.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/06.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/07.jpg"><br>用投照方法检查前牙缺损、龋坏：用口镜反射光线穿过前牙，只对前牙有效，当进行透照时，龋坏或者有充填体的前牙会出现暗影。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/08.jpg"><br>(口镜的分类，特点和使用方法。每天都用的东西，你真的熟悉吗？）<br>Section2：达到直视是不是一定是最好的？（Is achieving direct vision really best?）<br>对绝大多数牙科从业者而言，视觉是其最依赖的感觉。但在牙周治疗时，它会带来问题：<br>A.视觉不是你的朋友。牙科从业者进行牙周治疗时要意识到的最重要的事情是在治疗过程中触觉是TA们的最大助手，而视觉是其最大的障碍。抱着“直视是最好的”这样的观点会让医生为了获得直视而采取有害的<br>B.绝大多数龈下牙石应该用触觉来探测。牙周治疗最重要的因素就是从龈缘附近的牙周袋中的牙根表面去除菌斑生物膜和牙石。①通过感知——触觉——探测龈下牙石的能力是有效去除牙石的方法；②如果医生没有培养出精细的感知牙石的能力，就不要去谈去除牙石。换句话说，不能靠盲目用力刮治随机的去除牙石；③医生能准确感知到牙石，刮治时就会用更小的力。训练有素的医生只在去除牙石时用力。当探测牙石时，训练有素的医生会放松身体。<br>决定采用直视视觉可能产生的人体工程学问题：可能会导致不自然的体位从而带来肌肉紧张。斜方肌的持续静态姿势与颈部和肩部损伤有关。<br>掌握间接视觉是关键：当医生不能在保持正确体位的情况下获得直视的时候，就必须使用间接视觉来避免采用有害的体位，尤其对颈部和背部。<br>A.日常使用口镜采取间接视觉的牙科专业人士较少出现头部和颈/肩部的疼痛不适。<br>B.尽管20世纪80年代关于采用间接视觉的研究已经进行了很多，但是这么多年来间接视觉的技术并没有改变。<br>首先在上颌牙弓练习使用口镜。<br>（我不是初学者了——大多数读者也不是，略过）<br>（总结：不要为了获得直视视觉而采用错误的体位，而应该为了维持正确的体位而采用口镜获得间接视觉。）<br>Section3:技术练习，右利手者(Technique Practice: Right-handed Clinician)<br>1.用口镜牵开颊部。<br>step1<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/09.jpg"><br>①对上颌左侧后牙颊侧，使用10-11点钟位置。<br>②用左手握持口镜。<br>③将口镜头放置在牙弓之间（指上下牙弓吧），并且反射面平行于上颌颌平面。<br>④将口镜往后滑直到与第二磨牙成一条直线。<br>step2<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/10.jpg"><br>⑤翻转口镜头部，直到口镜头部与颊粘膜平行。口镜后部靠在颊粘膜上，口镜的反射面面对着牙齿的颊侧。<br>⑥在患者的颊侧建立口外支点。<br>⑦用手臂肌肉作为阻挡。只用手指肌肉来拉是一个困难和令人疲劳的方法来牵拉颊部。<br>注意避免口镜头部碰到患者牙齿，或者口镜的外缘碰到患者牙龈。<br>不要用口镜柄来进行牵拉。这会给患者带来不舒服。<br>2.上颌前牙，舌侧：靠近医生一面。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/11.jpg"><br>①坐在8-9点钟位置。<br>②左手握持口镜，无名指和小指放在患者右颊或者前磨牙上。<br>③调整口镜头部的位置，在镜像中看到牙齿舌侧。<br>④旋转口镜头部使其面对着你自己可以更容易在口镜中见到反射影像。<br>3.上颌前牙，腭侧，远离医生的方向。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/12.jpg"><br>①坐在11点到1点的方向。<br>②左手无名指和小指在患者的左颊或上颌前牙切缘做支点。<br>③注意口镜头部不要接近上颌前牙，而要接近舌头。<br>④翻转口镜使得反光面远离你，会更容易看到。<br>4.上颌右侧后牙，颊侧。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/13.jpg"><br>①坐在9点钟位置。<br>②口镜滑动到牙弓之间，无名指和小指在患者的右侧面部。用口镜拉开颊粘膜。<br>③使用口镜进行间接观察，特别是观察牙齿的远中牙面。转动口镜头部，直到你可以容易的从口镜反射面看到牙齿的远中面。<br>5.上颌左侧后牙舌侧<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/14.jpg"><br>①坐在9点钟位置。<br>②左手无名指和小指放在患者右侧面部，接近口角处。<br>③口镜头远离牙齿，靠近舌头。<br>④使用口镜间接观察，尤其是牙齿的远中面。旋转口镜，直到你能在口镜反光面容易的看到远中牙面。<br>6.上颌右侧后牙颊侧<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/15.jpg"><br>①坐在10-11点钟位置。<br>②口镜放到牙弓之间，左手无名指和小拇指放到左侧面部。<br>③使用口镜将颊粘膜推开牙齿。<br>④翻转口镜直到你可以在口镜中容易的看到远中面，颊面和近中面。<br>7.上颌右侧后牙，腭侧。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/16.jpg"><br>①坐在10-11点钟位置。<br>②左手无名指和小指在左侧面部放置，靠近口角的位置。<br>③口镜头部靠近舌头。<br>④翻转口镜头部在口镜中看远中牙面。<br>⑤翻转口镜看腭侧和近中面。<br>8.下颌前牙舌侧，靠近医生一侧<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/17.jpg"><br>①坐在8-9点钟位置。<br>②无名指和小指支点放在口腔靠口角处或者前磨牙上。<br>③使用口镜轻柔的推舌头，以暴露前牙舌侧。<br>9.下颌前牙舌侧，远离医生<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/18.jpg"><br>①坐在11点-1点位置。<br>②左手无名指和小指支点放在左侧面部靠近口角的位置，或者在前磨牙上。<br>③使用口镜轻柔的推舌头，以暴露前牙舌侧。<br>10.下颌右侧后牙，颊侧<br>①坐在9点位置。<br>②支点放在患者右侧面部。<br>③使用口镜牵拉颊粘膜，使用口镜进行间接观察，尤其是牙齿远中面。<br>11.左侧下颌后牙，舌侧<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/19.jpg"><br>①坐在9点钟位置。<br>②手指支点放在右侧面部。<br>③使用口轻轻微推开舌头，在口腔中线附近。使用间接视觉观察牙齿远中和舌侧表面。<br>④Tip：避免用口镜按压口底。<br>12.下颌左侧后牙，颊侧<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/20.jpg"><br>①坐在10点-11点钟方向。<br>②手指支点放在左侧面部。<br>③用口镜牵开颊侧粘膜向下远离牙齿。<br>④用口镜观察牙齿远中，颊侧和近中。<br>13.右侧下颌后牙舌侧<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0084-yzgzjc14/21.jpg"><br>①坐在10-11点钟方向。<br>②手指支点放在患者左侧面部。<br>③使用口镜头轻推舌头向后以暴露牙齿舌侧面。用口镜反光观察牙齿远中，舌侧和近中。<br>口镜表面结雾的处理：<br>①与患者颊粘膜接触温暖口镜表面。<br>②请患者用鼻子呼吸。<br>③在口镜表面擦商品除雾剂(defogging solution)。<br>④用湿的纱布擦拭口镜表面。<br>(总结：口镜的使用，不用死记位置，原则就是保持正确的体位，看不到就用口镜。口镜不要碰到患者牙齿和牙龈——尤其牙龈。）<br>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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